enlarged aorta

[t-hut-t]

I'm 60.  Just had an echo.  I have occasional PVC's (self-diagnosed!), thus prompting the echo.  I'm otherwise very healthy. The echo also revealed an "incidental" finding (cardiologist's language) of aortic "aneurysm."  41mm at aortic root.  49mm at sinuses of the Salvalva.  No other symptoms.  Good blood pressure, good cholesterol, good function, etc.  No regurgitation, slightly enlarged left ventricle.  

I have been a very competitive athlete for most of my 60 years, continuing to do interval work for bicycle racing and many similar things.  I, and my nurse wife, believe my aorta is a morphological change as a result of a lifetime of training.  My internet research confirms this to some extent, as well as the general information that the aorta grows .3 to .5 mm per year anyway.  Is it possible that my enlarged aorta is primarily a function of years of high intensity workouts?

I am not stupid, so I will have my 6 month follow-up echo as recommended, but in the meanwhile I'd like any reason not to worry!

[Forum-M.D.-MJM]

Hello,
In cases like this the important focus is on rate of progression.  It sounds like a relatively low risk issue that requires follow up to evaluate the rate of progression.  In the grand scheme this does not sound like an issue that you keep you up at night -- it was an incidental findings and not causing symptoms.  You are correct that follow is important, but please don't worry.  Regarding the cause, I have not read that exercise can do this.  At your age with only mild enlargement, I doubt you will find a definite cause. This is not how genetic syndromes usually present.

I hope this helps.   Thanks for posting.

[t-hut-t]

Er..... commenting on my own post.  That was sinuses of the Valsalva.. Ooops

[runnertom]

  Do you know what your blood pressure is during exercise? After 30 years of competitive running and cycling I was found to have an LAD blockage along with the first diagonal in spite of a "clean" risk profile. Since the bypass surgery, I have determined the problem may have been the result of exercise induced hypertension. My resting bp was low normal, but on the treadmill it will hit 230/110 at 13 or 14 minutes. I am now 59, 4 years after the surgery.
   I had other changes characteristic of high blood pressure, such as enlarged and thickened left ventricle. You may find it interesting to review this article that speaks to elevated blood pressure in older athletes: J. Am. Coll. Cardiol. 2006;47;794-798;. I don't know that its your problem as it is (was) mine, but I think the role of blood pressure in the older athlete may be overlooked. We may be doing things with our bodies that medicine knows little about.
   I have personally started on a beta blocker (metroprolol, 25 mg twice daily-as much as I can tolerate) and try to keep my pulse below 160. I don't get too excited about exceeding that occasionally, but I guess winning the Tour (de France) will have to go to someone else.

[mkrobi]

Just came from doctor's office and was informed that the mri of my heart showed that I have an enlarged aortic root of 4.8 cm and was wondering if anyone would be aggresively seeking treatment or wait for another reading of an mri in a few more months?

[tpres1116]

Well, I am on my way tomorrow morning for a CT scan. I had an echo 2 weeks ago for follow up to a mitral valve reguirgation finding last year. The echo showed a dilation of the aortic root. HMMM not knowing what this is I have spent a lot of time on line reading, and not liking what I have seen so far. I dont have any measurements yet but will update as soon as I know.

[pbanders]

I raced bicycles competitively from 13 until I was 45. I was diagnosed at 46 with a 5.0 cm ascending aortic aneurysm. One month later, I had surgery to repair the aneurysm with a dacron graft. I still ride, but I'm on a beta blocker now to reduce peak systolic pressure, which reduces my aerobic capacity somewhat.

From my research, intense aerobic and anaerobic exercise does not cause ascending aortic aneurysms. As the doctor says, the root cause is genetic, either FAA or some variant of Marfan's or E-D. Make certain to continue your monitoring and don't dismiss this as "normal". You can make an excellent return to cycling if you require surgery.

[clavus]

You may have a bicuspid  aortic valve  http://bicuspidfoundation.com/ (1-2% do, including athletes like us, and it usually can be seen on the study that found your aneurysm.) I say this because it will predispose you to both thoracic aortic aneurysm and labile hypertension.If so,it is time to consider the dacron graft and probably a new or repaired aortic valve as you approach 5 cm dilatation anywhere in the aorta (versus the 5.5 cm you might get quoted.) I got mine fixed at 4.9 because of chest pains and distance from a major med center. It's time to get on a beta blocker asap to reduce the maximum blood pressure against the weakening aorta. A Beta blocker will reduce your BP and pulse rate while resting and especially while exercising. There are reports that, while on beta blockers, the aortic pressure is higher than the recorded brachial (arm) BP, which gives a possibly false sense of improvement. But my symptoms improved rapidly on Toprol as I awaited surgery. Other BP meds to reduce "afterload" should also help but have not been proven to.If you back off exercise, and especially heavy weight lifting, you may be able to greatly slow the worsening of the aneurysm. I liken the aneurysm to a bulge in a garden hose near the faucet--you can make the hose last if you use it at reduced water pressure. But you know it is weak and getting a thinner wall as it expands and your gonna have to fix it someday. Meantime, progress is rapidly being made in repair techniques and ultimately in organ regeneration (so you can have a valve or aorta custom grown and slipped up to your heart through the blood vessel in your groin!)  If you don't yet own an Omron BP machine, buy one and see where you are during different activities and with medication adjustments.The chance of dying during surgery is a couple percent or you can take your chances and hope your aneurysm doesn't dissect like John Ritter's.  http://www.aorticdissection.com/ You need to talk to an aortic specialist . Cardiologists and cardiac/vascular surgeons are specialists in clogged arteries and don't usually have much expertise re: thoracic aortas.

[pbanders]

Very good advice and info from clavus....

[EchoTech]

The echo would have determined if there was a stenotic bicuspid valve or not.  He didn't mention that, so it is more likely the idiopathic enlargement of the sinus of Valsalva.

[Schmoomcgoo]

Careful, Grasshopper...a bicuspid aortic valve need not be stenotic to be associated with an ascending aortic aneurysm.  The mere existence of a BAV predisposes the ascending aorta to dilatation even in the presence of normal hemodynamics.  Whether a BAV is revealed by a transthoracic echo is entirely dependent upon the quality of the echo and the skill of the interpreter.  While the classic "fish mouth" is the presentation of the classic BAV, many BAV's do not fit the classic description and are not as easily identified as you may have been led to believe...nor do all tricuspid aortic valves present with the classic Mercedes icon.

[minmo]

I am a 50 year old male with a history of chf and tachybrady syndrome, and have a pacemaker. Recently I had an echocardiogram done and the dr. said that my aortice arch was enlarged. compared to a previous echo taken 2-3 years ago it had grown from 3.5 to 4.2 there are looking at previous CT scans and I had a ct scan done today. If it turns out that I need corrective surgery what will it entail and how long is the recovery? Thanks

[IRNMAN]

I have been reading all the comments and find them all interesting, I had a random body scan done (ct) 3 years ago. I am going to be 50 this year, the scan showed that i have a 5.2 cm ascending aortic aneurysm, the root is 4.8 cm. I have been doing triathlons for 20 years, i have completed 13 Ironmans triathlons, 20 marathons and many numerous shorter distance events. It was a real shock to me to find this problem, the recommendation when i found it was to monitor it every 6 months (ct) and no competative sports. Since my diagnoses i have done 3 ironmans and 2 marathons, i am on a beta blocker and all my training and racing my heart rate is 140bpm or lower. Everyone, my wife, kids, parents including myself are getting more nervous, we discussed getting the repair done this fall with my surgeon and he is in full agreement. I still want to continue with my athletic endeavors, they seem to be part of who i am and if i what to continue the recommendation is to get it fixed. I have looked at many different surgeons and one of the best in the world is a Canadian from Toronto, Dr. T. David, he is at the University of Toronto, General Hospital. Dr. David has developed a technique to spare your aortic valve so you would not require an artificial valve, only if your valve is in good condition.
It is a tough decision to get the surgery done, i have no symptoms and my aneurysm has not grown in 3 years. I will have to have it repaired in my life time, don't want to take the risk anymore, it adds to much stress. They also tell me that excersize will not increase the diameter of my aorta if i did not have this disease.

[NavyBAV]

IRNMAN, your case sounds very similar in diagnostics to my own, only I am younger (33) and don't have the benefit of 3 year case history (was just diagnosed).  I'm not a triathelete, but am athletic (in military).  I never would have known about this (no symptoms) except that I had a son born diagnosed with Bicuspid Aortic Valve (BAV) and so I was recommended to get a screening which found BAV and the ~5.0* cm SVA (root dilation).

Do you have a BAV?
How did you convince your doctors to let you go 3 years like this?  My doctors are pushing for surgery in the near term, and while I don't want to disagree, being an engineer I would like to get a sense of trend on this, is it getting worse or staying the same?

Should surgery be required in my case, I am also going to push for the valve-sparing procedure.  I'm told that even though I have BAV, since it is well-functioning with low AI, I still could be a candidate for the valve-sparing.  I've heard cuminen is difficult to be on, and to be avoided if possible.

*exact measurement subject of ongoing debate amongst several doctors- TTE/TEE shows 5.3/ MRI&CT show ~4.7.

[pbanders]

FWIW, I'm 49, I raced bicycles on and off from 13 to 36, and rode about 100-200 hard miles per week from 36 onwards. In '04, I was diagnose with a 5.0 cm ascending aortic aneurysm, I had surgery to repair it one month later. I did not have to have the valve replaced, and I was put on 50 mg daily of metoprolol (beta blocker) and an ARB for blood pressure management (never had high BP before the surgery, these steps were precautionary). I resumed riding in about 6 weeks, and regularly ride 100-200 miles per week. I've lost about 10-15% of my aerobic capacity due to the beta blocker, and anerobic effiorts are not as good as they used to be, but I can still ride fast and have no other issues. It's a risk vs. benefits decision - do you live with a 5+ cm aneurysm and hope that it doesn't dissect (a true disaster) so that you can perform at top capacity, or do you have the surgery and possibly lose some capacity if you're on a beta blocker?